The books starts with the staggering facts about erectile dysfunction. The prevalence rate for men who are 40 is 39% and increases to 67% for men who are 70. The authors point out that as baby boomers age, many more men will be affected by this problem. They do discuss medical interventions for erectile dysfunction but I thought they did a good job of focusing on the psychological factors in a chapter entitled, "Assessment of Psychological Risk Factors."

The major risk factors include: vulnerabilities within the individual, factors arising from the family of origin, and relationship issues. The book uses a systemic approach to treating the problem and does not automatically assume it lies only with the man. At one point, the authors suggest to therapists "not to assume that her [my emphasis] inhibitions, if present, were precipitated by him."

In another chapter on couples' relationship problems, the authors address anger and conflict issues and they make a good point: "The question is not whether anger and conflict occur between partners, but how they manage it when it does occur."

Overall, the book seems to have good information on treating erectile dysfunction and looks from my perspective to be a good resource for therapists, physicians or those who want to understand more about the problem.

42 Comments:

I have never seen a subject weighed in by so many counselors, sex therapists, urologists, experts and professionals with one opinion and the cold reality of the subject be something so different. I'm going to get a good laugh over this discussion about erectile dysfunction, go ahead experts and dazzle us all.

Erectile dysfunction?! I thought it was reptile dysfunction. But, then, it is referred to as a snake sometimes.

BTW- in my experience this is never talked about between men (and maybe women). I've never heard it brought up in any conversation, anywhere, in which someone was referring to their or their spouses problem. Or, maybe I just happen to always be with a particular virile group of men, which I doubt.

I am just guessing because I do not have this problem and don't expect to. I suspect it is related more to the wife than the husband. As a man gets older, so does his wife. She becomes flabby, fat and unattractive and his ability to be aroused by her falls off as a result. Ethical boundaries constrain the man within his marriage and he learns to get by with less. It is also not very likely that a man will admit in a couples therapy session that his wife no longer arouses him. Most men are smarter than that. A lifetime of marriage teaches men to lie well.

It would be interesting to see if there is any study among men with younger wives for differences in the rates.

and you'll end up with a population of afflicted men whose numbers would never warrant books, TV spots, endless TV commercials and that glassy-eyed moron, Smilin' Bob.

This is nothing but the American pharmaceuticals industry going off on a money-grubbing tear.

I used to live next door to a 67-year old man whose wife loudly and regularly remarked of his voracious sexual appetite. He never smoked, drank only wine at dinner and jogged 5 miles a day until his knees made him walk ten miles instead.

I think all of you are missing the point. What man in his right mind is going to brag about his ED?

The American pharmaceutical industry is making a bundle selling Viagra, Cialis, etc., and this simply would not be happening if there were no market. The fact that men do not talk about it does not mean that the problem does not exist. The MDs hear about it, not the guy in the next cube.

i`m usually too tired, or something is on my mind....and my wife understands and waits a couple of hours, or until morning, which is generally better for me anyhow.

some of the artifacts of a 15 year controlling relationship still weigh in occasionally i might add...and as i explore some of those issues (from a safe distance) i discover just how much they still influence my life now.

the two products that work for me are horny goat weed (no joke!) and a product called forta, which i save for special occasions...because my wife deserves the best.

The fact that most of the commercials include the phrase 'Ask your doctor if your healthy enough for sexual activity' is a pretty good indicator that these drugs are mostly making up for a lifetime of unhealthy habits. I've had some experience with ED caused by a combination of being out of shape and overconsuming OTC pain killers following an accident where I busted up my shoulder. That was hard.. uh, more difficult than just poppping a pill. Once I fixed those issues I improved quite a bit though I have learned to scale my expectations to the fact I'm 48, not 28.

Prof Hale's post was a bit crude but there is a grain of truth to the joke about the man who needs Viagra with his wife, but not with the housekeeper.

i suffer from niether cardiovascular disease or am i on anti-depressants, though these are evidently factors of ED.

my drive allows my wife and i sometimes twice or three times in a day.

we laugh and call ourselves a rare anglo-saxon mating pair (ornitological reference), but occasionally we are presented with a non-starter, generally in the late evening, and we love eachother anyway and do something else together.

i think in many mature relationships the simple fact that a spouse is unattractive to the other is a common issue and not one that needs to be medically treated, but the fact remains that many overweight emotionally unavailable women are getting some now is attributable to a little blue pill.

my ex asked me to ask the doctor for some viagra, and he said that i didn`t love her any more.

"i suffer from niether cardiovascular disease or am i on anti-depressants, though these are evidently factors of ED."

Chicken and egg...is it the antidepressant drugs or the fact one is depressed to begin with?(The same could be asked of the acne drug accutane.) I have known some people with mental issues who get those "side effects" when they go on the drugs so I'm sure it's not just one or the other.

my drive allows my wife and i sometimes twice or three times in a day.

Reminds me of the old fella who went to the doctor complaining of having difficulty performing sexually. The doctor asked when he first noticed his problem. The old fella says, "Twice last night and once this morning."

Sorry, I've had a really busy day. I'll have to break this up in 2 posts. I'm laughing at all the experts and their comments, not the affliction.

Okay, let me weigh in with my opinion. There are 2 competing challenges with erectile dysfunction. The first challenge is that men often may define themselves through sex. Men find it very important to become aroused, to perform sexually and have an orgasm. Some think this is biological, I think it is more cultural. Men's importance within the household has been slowly diminished. They aren't needed much for heavy lifting because there is less heavy lifting to be done. Financially women can earn money and pay the bills. We have all sorts of media and peer pressure for men to be sexual beings, get laid, laid often and sometimes to get laid by many women. Sex has become increasingly more important to men in the last few years.

Then there is the other problem. The increase in weight and decrease in exercise. The girth of all waist lines is expanding at a record rate. Depression rates are probably staying steady though lifespan is increasing. Men's food choices often lead to unhealthy fatty foods that wreak havoc on the heart and veins. As another poster pointed out, all of this decreases blood flow to various organs including the penis.

So what we end up with is men are desperate to have sex and have an orgasm, but an ever increasing group of men is having trouble doing the deed. I don't think I have told anyone here anything new so let me move on with the reality part.

I'll be hypothetical here, but maybe there isn't much hypothetical about what I have to write. I'm going to get graphic here so if you don't like it quit reading.

A man and woman decides to have sex. He's excited, she's excited. They take their clothes off. His penis doesn't work. He suggests a blowjob, she gives him a blowjob. He gets an erection. He refuses to perform foreplay on her because he feels the erection might be short-lived. They have sex. He loses the erection. He wants a handjob, a blowjob, anything. She's getting irritated. He prods her into getting his erection back. They continue to have sex. She stays perfectly still lest any movement upset the erection situation. He concentrates on his pleasure and his orgasm. After 20 minutes of pumping he finally comes. He rolls over and falls asleep satisfied that he has performed successfully. She knows only one thing, the relationship has to end and the sooner the better.

Viagra is another side of the same coin. With all the psychological experts, medical experts and men talking about their deep personal issues and how they must have sex, perform sexually and be the man in the bedroom I don't see anyone talking about how their partner feels about the erectile dysfunction acrobatics they are forced to perform to keep the illusion that all is fine and dandy with the poor performing penis. Ask any woman over the age of 40 and they all have their own horror stories about this.

Say what you want. I smoked most of my life, and yes, it causes vascular problems. I had a prostate the size of a tennis ball. Yes, it caused problems. Flomax caused even more problems. There are a couple other things, all have been dealt with.

Long and short, beta sitosterol removed the prostate problem. Viagra works like a champ. Some testosterone replacement (had a tumor on my pituitary gland) and I am literally 25again.

Like I said, say what you want. There are physical as well as phycological reasons. Mine were physical, and my problems are gone.

I don't see anyone talking about how their partner feels about the erectile dysfunction acrobatics they are forced to perform to keep the illusion that all is fine and dandy with the poor performing penis.

The women in the Cialis commercials look really happy. That's good enough for me.

1. Physical age and problems with the blood vessels and nervous system (exacerbated by obesity, smoking, etc.), or prostate problems.

2. Unaddressed resentments between spouses.

I suspect that the #1 situations are relatively easy to identify in the majority of cases. #2 could well be more common... The fact is that a lot of buried emotional crap can reduce the effective libido. Even a man finds it difficult to be turned on by someone he quietly loathes.

To put it bluntly, if someone finds women attractive, and pornography to be a turn-on, but somehow suffers "erectile dysfunction" with his wife, it's not a physical problem we're dealing with, here...

Just a side note, but why do we have a system in which a man has to go to a doctor to beg for viagra; the doctor will at most measure his blood pressure and ask if he uses some nitro compounds ... and then prescribe it. Just prescribe it the same as if you answered the same questions on the Internet. After the doctor gives a stern look with a raised eyebrow like Spock on Star Trek, of course. Depending on the doctor, you may also have to pay homage to his greatness.

Just get it on the Internet (at a trusted site).

The best health care reform: That Americans see through the myth that physicians are Gods.

"To put it bluntly, if someone finds women attractive, and pornography to be a turn-on, but somehow suffers "erectile dysfunction" with his wife, it's not a physical problem we're dealing with, here..."

Well. perhaps.

You keep hearing that, but I wonder. Pornagraphy, the stimulation is visual and mental, all in your mind. So that's one way.

But in bed, with another person, more sensation, no fantasy, hardly any visual. and you might not really want the visual. All kinds of emotional crap, too.

It's a different route, so does the brain treat it the same? Could still be a physical problem, I theorize. The systems involved are very complicated.

+1 to Tether! check out "Fred on Everything", and his comparisons of our medical tyrany, compared to Mexico's freedoms. You want an anti-biotic? You go to the drugstore, and YOU BUY IT. Five bucks, you out of there. now ThATS a free country!

It does a heck of a lot more to you than just throat and lung damage. The vascular damage can be halted, but not reverted. And living with only one lung puts a serious damper on your capabilities, perovided you survive in the first place. And it will offset the cost of Viagra.

Br549, erectile dysfunction is like a lot of other afflictions. Smoking, drinking, lack of exercise and a bad diet are going to contribute. Do you really think people want to seriously consider a lifestyle change when a blue pill will solve the problem? The pharmaceutical companies are fat and happy churning out Lipitor, Viagara, and thousands of other concoctions that wouldn't be necessary if people changed what they did. Doctors get speaking fees and steak dinners from pharmaceutical companies for not suggesting a lifestyle change and writing those prescriptions. One can write scrip in less than a minute, thereby the doctor get to see and bill more patients. Talking about weightloss, smoking cessation, stopping that lifelong drinking habit is too much effort, makes your customers unhappy and most likely will fall on deaf ears.